Medical Aspects of Lightning
How Big A Problem Is This?
Lightning has been the second largest storm killer in the U.S. for the last 40
years, exceeded only by floods. A lightning strike can result in a cardiac
arrest (heart stopping) at the time of the injury, although some victims may
appear to have a delayed death a few days later if they are resuscitated but
have suffered irreversible brain damage.
According to Storm Data, a National Weather Service publication, the U.S.
averages 67 reported lightning fatalities per year. Due to under reporting, the
figures are more realistically about 100 deaths per year. Only about 10% of
people who are struck by lightning are killed, leaving 90% with various degrees
of disability.
|
ODDS OF BECOMING A LIGHTNING VICTIM
|
| U.S. 2000 Census population |
280,000,000 |
| Odds of being struck by lightning in a given year (reported deaths + injuries) |
1/700,000 |
| Odds of being struck by lightning in a given year (estimated total deaths +
injuries) |
1/240,000 |
| Odds of being struck in your lifetime (Est. 80 years) |
1/3000 |
| Odds you will be affected by someone being struck (Ten people affected for
every one struck) |
1/300 |
Who Gets Injured
While about one third of all injuries occur during work, workers compensation
companies are often reluctant to acknowledge the injury or pay related medical
expenses. About another third of injuries occur during recreational or sports
activities. The last third occurs in diverse situation, including injuries to
those inside buildings.
How Do Lightning Injuries Affect People?
Lightning tends to be a nervous system injury and may affect the brain,
autonomic nervous system and the peripheral nervous system. When the brain is
affected, the person often has difficulty with short-term memory, coding new
information and accessing old information, multitasking, distractibility,
irritability and personality change.
"Patients have difficulty in all areas that require them to analyze more items
of information than they can handle simultaneously. They present (appear) as
slow because it takes longer for smaller than normal chunks of information to
be processed. They present as distractible because they do not have the spare
capacity to monitor irrelevant stimuli at the same time as they are attending
to the relevant stimulus. They present as forgetful because while they are
concentrating on point A, they do not have the processing space to think about
point B simultaneously. They present as inattentive because when the amount of
information that they are given exceeds their capacities, they cannot take it
all in."
Early on, survivors may complain of intense headaches, ringing in the ears,
dizziness, nausea, vomiting and other post-concussion types of symptoms.
Survivors may also experience difficulty sleeping, sometimes sleeping
excessively at first and then only two or three hours at a time. A few may
develop seizure-like activity several weeks to months after the injury.
Personality Changes / Self-Isolation
Many lightning victims may suffer personality changes because of frontal lobe
damage and become quite irritable and easy to anger. People who wake up after
the injury often do not have the ability to express what is wrong with them,
may not recognize much, become embarrassed when they cannot carry on a
conversation, work at their previous job, or do the activities that they used
to handle. As a result, many isolate themselves, withdrawing from church,
friends, family and other activities. Friends, family and co-workers who see
the same external person, may not understand why the survivor is so different.
Friends soon stop coming by or asking them to participate in activities.
Families who are not committed to each other break up.
Obviously, depression becomes a big problem for people who have changed so much
and lost so much. Suicide is something almost all severely injured people have
thought about at one time or another. Occasionally, those who do not have
access to medical care or who do not understand what is happening may resort to
alcohol and other drugs, particularly those who have previously used these
options. Family and friends of the survivor must remain supportive even though
it may require an adjustment in their relationship with the survivor. An injury
such as this affects the entire family, not just to the person hit. Fatigue
Survivors often complain of becoming exhausted after only a few hours of work.
This may be because tasks they used to do automatically now require intense
concentration. Many return to work but find that they cannot do all of the
activities required at their job.
Medical Testing
There are two kinds of medical tests:
-
Anatomic tests take a simple picture (x-ray) or measurement (blood count)
-
Functional tests show how something is working (PET, neuropsychological
testing)
Sometimes function can be ascribed to the anatomic tests but often it cannot.
The mental changes of a lightning survivor are functional (how the brain works)
changes, not anatomic. Anatomic tests such as a CT scan and MRI are usually
normal. More functional scans such as PET and SPECT may show changes but are
hard to obtain due to their relative infrequency in medical centers. To use an
analogy: if an electric shock were sent through a computer, the outside case
would probably look OK (similar to a photo or x-rays of the person), the
computer boards on the inside would probably look OK and not be fused nor
melted (CT, MRI for the person), but when you boot up the computer it would
have difficulty accessing files, making calculations, printing, etc. This
situation is similar in a person with brain injury who has short-term memory
problems, difficulty accessing and coding information, difficulty organizing
output, etc.
More useful is a functional test of how a person's brain is working: a
neurocognitive or neuropsychological testing. These tests are administered by a
neuropsychologist, not by a psychiatrist. The tests consist of a 6-8 hour
battery of tests including memory, IQ and organizational ability. Survivors of
lightning and electrical injury usually have a characteristic pattern of
deficits.
Delayed Problems
Another common, often delayed, problem for some survivors is pain, also
difficult to quantify and manage. The pain may not be from chronic intense
headaches but may be in the back (perhaps from compression and disc injury from
the intense muscle contractions which may throw a person several yards at the
time of the injury), or in an extremity. Some may have nerve entrapment
syndromes and a small number may eventually develop Sympathetically Mediated
Pain Syndrome.
Sometimes the functional tests ordered are testing the wrong thing. An
electromyogram (EMG) measures only the motor fibers, which are seldom affected
by lightning injury. Smaller pain carrying nerve fibers are not tested by EMG
so that a normal EMG means little when ordered for someone with pain. Likewise,
the standard EEG primarily measure surface readings of the brain and misses
seizure activity in several deeper regions.
Decreased libido and impotence are often reported.
Help Exists - Lightning Strike and Electric Shock
Survivors, International, Support Group
An organization of tremendous help to survivors, families, physicians and other
professionals is Lightning Strike and Electric Shock Survivors, International
(LSESSI), a support group formed in 1989 by a lightning victim. LSESSI has
printed materials, offers tremendous support, networks survivors with others in
their area, and provides an annual meeting where survivors come together for
support and lectures from professionals who work with lightning and electrical
survivors and their families. LSESSI can be reached at 910-346-4708,
info@lightning-strike.org, or see their Website at
http://www.lightning-strike.org/, or at P.O. Box 1156, Jacksonville, NC
28541-1156.
Four Factors Necessary for Recovery
The four most important factors in overcoming disability from lightning injury
(or from any illness or major injury for that matter) are:
-
Supportive family/friends network.
-
Becoming your own advocate and learning as much as you can about this
disability.
-
A physician willing to listen, read, learn and work with the survivor and their
family.
-
A sense of humor.
Prevention
Far more important than treating survivors is preventing lightning injury. All
of the people who helped make possible
National Lightning Safety Awareness Week hope it will help you and your
family learn how to avoid injury.
Prevention is the KEY.
This factsheet courtesy
Dr. Mary Ann Cooper- Associate Professor, Departments of Emergency
Medicine and Bioengineering University of Illinois at Chicago.